ISSN: 2320-5407 Int. J. Adv. Res.

11(05), 925-931

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/16948
DOI URL: http://dx.doi.org/10.21474/IJAR01/16948

RESEARCH ARTICLE
GENDER DISPARITY IN AN ACADEMIC HOSPITAL: FEMALE HEALTH CARE
PROFESSIONAL’S PERSPECTIVE

Dr. Puja Ramakant, Dr.Shiuli, Dr. Chanchal Rana and Dr. Dipti Shastri
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History
Received: 20 March 2023
Final Accepted: 22 April 2023
Published: May 2023
Key words:-
Women Professional, Genders, Equality
Or Inequality, Tertiary Health Care
Center, Disparity, Academic Hospital
Objective: To determine whether gender-based bias is prevalent in the
workplace at a Tertiary Health care system in India
Design: Prospective Google form-based questionnaire qualitative study
Setting: Tertiary Healthcare Institute
Results:A total of 174 female faculties and residents were included in
the study. 18% of the participants reported mild gender-based
discrimination at the workplace. 8.5% faced sexual harassment. While
about a third (33%) faced mental harassment. Only two- a fifth were
content with their jobs, whilst 23 % felt they could not get adequate
institutional support for their professional development.
Conclusion:Our results cast a light on the role of gender in relation to
work opportunities, sexual and mental harassment, and work-life
balance. Though women are making progress but remain disadvantaged
at a professional level and gender discrepancy still persists.

Copy Right, IJAR, 2023,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Female physicians have blazed a difficult path from the nineteenth century’s institutional barriers through the
twentieth century’s social and psychological encumbrance to the twenty-first century when more girl students than
boys are enrolling in medical courses [1,2]. Despite this decreasing gender disparity there is still an
underrepresentation of women in academic as well as leadership positions. Many factors like unequal access to
opportunities and resources, conscious/unconscious gender bias, and unequal support for work-life balance have
been contributing to this inequality.

At the time of Indian Independence, the medical profession had a meager representation of women. There has been
an upward growth in women earning degrees in medicine from only 5% of women (of the total) earning a degree in
the field of medicine in 1952 to about 50% earning in 1988. In the previous decades, there has been a significant
increase in the proportion of female doctors.However, the same positive trend could not be seen at the postgraduate
and doctoral levels which only increased to one-third [3]. The shift could be attributed to several reasons. Primarily
it was Indian societal thinking which hindered the acceptance of women as part of the medical profession. This also
adversely led to women staying away from hospitals also as many were not prepared to be treated by male doctors.
Another reason was the opportunity that the economy provided to women at large to partake in the development of
the country by loosening the autocratic control which encouraged private investment in many fields, medicine being
one among them. Although it led to an improved gender balance in the country as happening globally [4], yet to
recapitulate, women are still underrepresented in leadership positions.

Corresponding Author:- Dr. Dipti Shastri

925
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

Over the past decades, the number of women physicians has increased from less than 10% to more than 40% of
practicing physicians in Western countries [5,6]. Gender disparities exist for women in academic medicine in the
assistant, associate, and full professor ranks as well as in leadership positions[7,8,9].The gender inequality approach
is concerned with the role of gender in relation to work opportunities in the workplace, family support, sexual or
mental harassment, and respect from the patient between the genders. [10]. In previous years, there was a lot of
literature related to gender inequality but there were very less studies related to gender inequality in the tertiary
healthcare system in India. This article evaluates the prevalence of gender disparity in theworkplacein a tertiary
health care system in India.

Methodology:-
We planned to do a prospective observational questionnaire-based qualitative study to know about the existing
gender inequality prevalent among the female faculty and residents in our Medical University. A Google form-based
questionnaire was designed keeping in mind various components like work satisfaction, mental or physical
harassment, respect by patients and colleagues at the workplace, the balance between personal and professional life,
family support, stress, interpersonal issues, resistance or opportunities to grow and workplace challenges(Table 1 ).
This form was filled by the female faculties and resident doctors working in all the medical, surgical, and dental
departments of our University. The data were collected in an Excel sheet and statistically analyzed.

Results:-
A total of 174 out of 250 female faculties and residents (69.6 %) responded and filled out the questionnaire. The
mean age of the respondents was 26.5 years (range 18-55 years).The majority (73%)of the female staff were single,
23 % were married, and a few (1-2%) were divorced or separated. Regarding parity, 37% were nulliparous, 29% had
one child and 26% had two children (Table 2). Amongst all those who filled out the form, 14% were faculties, 86%
were resident doctors. Regarding the perception of equity for work opportunities at the workplace as compared to
male colleagues, 75 % felt that they got equal opportunity however 18% felt there was mild discrimination. 50%
felt stress at the workplace and between interpersonal relationships. 80 % felt there was no delay in their
promotions and the rest 20% documented a delay in their promotions. 47% felt they could well balance their
professional and personal lives however rest found it difficult to make the balance (Figure 1).

The majority 85.4% felt they never faced any sexual harassment at the workplace, 8.5% said that they had
faced some sort of sexual harassment from a colleague, and the rest 6.1% were not sure of the answer (Figure
2). 54.5% felt they did not face any mental harassment, 33% said they faced some sort of mental harassment
and the rest 12.1% were unsure of the answer.66.7% did not feel any sort of discrimination by their colleagues
as far as professional respect was concerned, 25.8% had experienced discrimination and 7.5% were not sure of
the answer. The majority 61.1% felt patients gave them equal respect as compared to male colleagues, 24.8% felt
that the patients respected male doctors more and the rest 14% were unsure of the answer.

The majority 63.5% could find flexibility at the workplace regarding leaves or modifications in work schedules,
17.6% did not find flexibility at the workplace and 18.9% were not sure of the answer. 39.7% had 100% work
satisfaction, 44% had good satisfaction and the rest had less than average work satisfaction. The majority 76.6%
felt they got adequate Institutional support for their professional growth and the rest felt they did not get adequate
support.

Regarding family support in their achieving professional status, the majority 89.9 % felt they got 100%
support, 8% felt some sort of support, 1% had no support and 1% said they were discouraged to pursue a
carrier at the family front or their family members were not educated and were not able to guide them. The
majority 81% felt they could find out time for social commitments while the rest found less time for
socializing. 45 % felt they could find out time beyond their working schedules to inculcate their hobbies, 31
% were not sure and the rest 24 % could not find out time to work on their hobbies (Figure 3).

Discussion:-
Gender discrimination is defined as any distinction, exclusion, or restriction made on the basis of socially
constructed gender roles and norms that prevents a person from enjoying full human rights. Gender discrimination in
the health care system has an indirect effect on women’s mental and physical health.Many women leave their jobs

926
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

due to this discrimination and this also happens after childbirth when they do not get adequate family support to
balance their personal and professional lives.

We interviewed a few faculties in our University and they shared their experience regarding this issue. One female
faculty said that she got married an internship and joined as a postgraduate student on her first marriage anniversary.
During her residency period, she was expecting her first child and delivered a son, and joined work on the 10 th day
after her surgery. As a Senior Resident, there were no maternity leaves granted to the female. She utilized her
pregnancy time and published many manuscripts. Later, she was selected as a Lecturer with the highest publications
as compared to other applied candidates. Another faculty said that she got married during her internship and was
expecting her first child during her post-graduation. However, managing both her studies and family life, she
completed her post-graduation successfully and joined as a Senior resident in the Dept immediately after her post-
graduation. She gave birth to her second daughter during her senior residency. After completion of her senior
residency, she had no job for almost one year, and with the responsibility of two children and in-laws to look after,
she couldn't even leave the city for any job. So whatever job options were available in the same city, could only be
extended to her. There came a break in her career as she advanced into her family life. Luckily, there was a post of
Lecturer advertised, and she was selected as a suitable candidate. This was the start of her professional career.
Another faculty said that she was doing a senior residency in a Government Medical College, where she was denied
maternity leave and had to resign. She could join another college as a faculty only after her son bit older.

Gender equality at the workplace enhances women’s participation because women play a critical role in both the
household and the professional community [11].Plenty of pieces of evidence have accumulated over the past half
century based on work in almost all the social sciences and humanities about the presence, scope and depth of
gender inequality and inequity throughout much of known history and in practically every part of the world [12, 13].

Gender discrimination against women can be in the form of differential wage rates in developed economies or it
takes the form of different access to education, health, and wage employment in developing countries. Gender
discrimination is a key factor operating in the health workforce [13]. Human resources for health experts have noted
that health workforce gender imbalances are a major challenge for health policymakers [14].They have also
observed that improving gender equity is essential to strengthening workforce numbers, distribution, and skills
[12,15,16,17].

In this study we found that more than half of the females at the Tertiary Health Care system felt that they got equal
opportunity at their workplace as compared to male colleagues and few felt mild discrimination.In Literature, there
are studies of gender discrimination and inequality in the public and private health employment systems in Zambia
and Uganda that found lack of policy responsiveness to life course events for workers with family responsibilities,
as well as evidence of sexual harassment, gender bias, and occupational gender segregation [18]. Studies from
Kenya have shown that in the medical cadre, there were 1.5 times more males as compared to females professional
and this gap increased to 4 times in specialties [19]. However, no such findings were found in our study population.
Recent statistics indicate that women represent about 35% of the total physician workforce, with female physicians
comprising 49% of the current medical student population in the United States. In New York State (NYS), female
doctors account for 38% of the physician workforce across specialties.

Countries like Uganda which apart from this disparity also reflected that there was a higher concentration of male
workers in the senior management positions in referral hospitals along with the presence of gender wage gaps
[20,21].This situation is worldwide and not limited to third-world nations and developing countries.

Developed countries like United States of America have also accepted that although gender disparities are
decreasing,women are still under-represented in the assistant,associate, and full-professor ranks as well as in
leadership positions [22].Some studies indicate that gender differences are less evident when examining younger
cohorts. In the present study the mean age documented is 26.5 years suggesting a younger cohort [23]. In this
institutional study almost half of these females felt stress at the workplace and between interpersonal relationships
along with difficulty to balance professional and family responsibilities. This was more encountered in residents
and faculties who were married and have children.

Very few women reach the highest level of medical position and it may be due to lack of adequate family support
and discouragement at workplace (24-27). In our University, 67% of female candidates were there at the

927
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

undergraduate level and that dropped to 44% in the postgraduate level. 8.5% of females reported some sort of
sexual harassment from their male colleagues and this figure rose to 33% when mental harassment was
considered. Sexual harassment is not a new term, it is a century-old phenomenon [28]. Sexual harassment is a
systemic and pervasive problem within healthcare, not a series of random acts. As a result, changing the abusive
gender healthcare culture, it requires a systemic, holistic approach to change management [29].

In a study from Spain, a significant difference was observed between women and men holding permanent medical
positions. These differences progressively increased in relation salary, and grade of advancement over hierarchal
promotion as well as over promotion [30]. Venkatesh et al in the study also documented that females are under-
represented in training programs, specialist positions, academic faculty, and leadership roles in intensive care. One
notable hypothesis, and perhaps one that is often discussed in the literature, is that women shoulder the majority of
family responsibilities, and this may result in women having less time for their careers [31].

Surprisingly, as opposed to many developed countries, India which is considered as a developing nation, provides
equal constitutional as well as economic rights to women. There is no pay disparity between male and female
employees of the sameprofessional levels. Also, there is no gender disparity in promotions which are entirely based
on seniority and time-based. Our study also proves this point as more than 2/3rd of the female health professionals
(resident doctors and faculties) responded that they had equal opportunities, timely promotion and adequate
institutional support for their professional growth.

This study shows the majority of the females at tertiary health care centres felt they got 100% family support,
some felt very little support, and others had no support, very fewwere discouraged to pursue carrier at the
family front because of lack of education. These findings were also noted in a study done byJolly and
colleagues on physician researchers and noted that women were more likely than men to have spouses or domestic
partners who were fully employed, spent 8.5 more hours per week on domestic activities and were more likely to
take time off during disruptions of usual child care [32].Carr and colleagues found that women with children
(compared to men with children) had fewer publications, slower self-perceived career progress, and lower career
satisfaction [33].

In our study, we found the majority had work satisfaction and the rest had less than average work satisfaction but
more than 70% felt they got adequate Institutional support for their professional growth. This finding was also
supported by Carretal as they recommended special attention for faculty by scheduling fewer departmental
meetings after working hours and making part-time tenures.Kaplan et al.found that family responsibilities do not
appear to account for gender differences in academic advancement [34]. Interestingly, in a study comparing
physicians from Generation X to those of the Baby Boomer age, Generation X women reported working more than
their male Generation X counterparts, and both had more of a focus on work–life balance than the older generation
[34].

It is essential to eliminate gender disparities in the existing healthcare system [11]. Related to flexibility at work
place, our study results showed majority 63.5% found flexibility at work place regarding leaves or modifications
in work schedules. Howell [35] recommended that Institutes should develop and enhance their own policies
through consideration of female faculty.

In our study we foundmore than 60% female doctorsfeltpatients gave them equal respect as compared to male
colleagues, but more than 20% felt that the patients respected more to male doctors. This finding were partially
supported by study done by Cecile etal [36] as they concluded that patient doctor gender discordance is associated
with their agreement or disagreement on advice given during consultation.

Conclusion:-
Hence to conclude, though mankind is taking a giant leap in technological and scientific advancement but at
social and professional level, gender discrepancy still persists and more holistic approaches are required to reduce
this disparity and to provide equality and equity to female health professionals.

928
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

Figure 1:- Data showing professional and personal life balancing issues.

Figure 2:- Work Satisfaction factors Data.

929
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

Figure 3:- Shows work place challenges.

Reference:-
1. Bhadra M. Indian Women in Medicine: an enquiry since 1880. Ind Anthropol. 2011;41(1):17-43
2. Ministry of Human resources development, Department of Higher Education, Government of India. (2019). All
India Survey on Higher Education 2018-19. New Delhi
3. Women in Modern Medicine in India: Progression, Contribution, Challenges and Empowerment.Australasian
Accounting, Business and Finance Journal 2019;13(2): 88-106
4. Jefferson L, Bloor K, Maynard A. Women in Medicine: Historical perspectives and recent trends. British
Medical Bulletin2015;114:5-15
5. Arrizabalaga P etal. Gender inequalities in the medical profession: are there still barriers to women physicians
in the 21st century. Gac Sanit 2014; 28(5) : 363-368.
6. Organization for Economic Co-operation and Development. Health data: Statistics and Indicators for 24
countries 2009; [consulted on 4/6/2011]. Available at: http://stats.oecd.org/index.aspx?DataSetCode =
HEALTH STAT
7. Association of American Medical College Women in U.S. academic medicine and science: Statistics and
benchmarking report. 2012. Available at:
http://member.aame.org/eweb/upload/Women%20in%20U%20S%20Academic%20Medicine%20Statistics%20
and%20Benchmarking%20Report%202011.20123.pdfAccepted September 1, 2014
8. Jagsi R, Guancial EA, Worobey CC, et al. The ―gender gap‖ in authorship of academic medical literature—a
35-year perspective. N Engl J Med. 2006;355:281–287
9. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic
advancement. Results of a national study of pediatricians. N Engl J Med. 1996;335:1282–1289
10. Standing H. Gender and equity in health sector reform programmes: a review. Health Policy and planning. 12
(1): 1-18.
11. Tiwari A etal. Gender equity and inequality in Indian Healthcare. GIHSR April-June 2020 ; 5(2) : 26-34.
12. Burden M. etal. Gender Disparities in Leadership and Scholarly Productivity of Academic Hospitalists. Journal
of Hospital Medicine ; August 2015 : 10 (8) : 481-485.
13. Bloom G. 1991. Gender and the Production of Health Care Services. Presentation to the Gender and Health
Workshop, Institute of Development Studies, University of Sussex, UK.
14. Zurn P, Dal Poz MR, Stilwell B, Adams A: Imbalance in the health workforce. Hum Resour Health 2004, 2:13.
15. Newman: Time to address gender discrimination and inequality in the health workforce. Human Resources for
Health 2014 12:25.
16. Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med.
2000;342:399–405. 6.

930
ISSN: 2320-5407 Int. J. Adv. Res. 11(05), 925-931

17. Reed DA, Enders F, Lindor R, McClees M, Lindor KD. Gender differences in academic productivity and
leadership appointments of physicians throughout academic careers. Acad Med. 2011;86:43–47.
18. Ministry of Public Service (Kampala, Uganda): Circular Standing Instructions Number 2 of 2011: Guidelines
for Gender Mainstreaming in Human Resource
Management(section3.3).http://www.publicservice.go.ug/public/Gender%20mainstreaming%20Guidelines-
%20May%2017th%20Final%20Final.pdf
19. Newman C, Kimeu A, Shamblin L, Penders C, McQuide PA, Bwonya J: Making non-discrimination and equal
opportunity a reality in Kenya’s health provider education system: results of a gender analysis. World Health
Popul 2011, 13:23–33.
20. Zeidenberg D: Interview with Richard Anker on occupational segregation, living wages, and international
poverty lines. 2006. http://www.peri.umass. edu/395/.
21. . Tijdens K, De Vries DH, Steinmetz S: Health workforce remuneration: comparing wage levels, ranking, and
dispersion of 16 occupational groups in 20 countries. Hum Resour Health 2013, 11:11
22. McManus IC, Livingston G, Katona C. The attractions of medicine: the generic motivations of medical school
applicants in relation to demography, personality and achievement. BMC Med Educ. 2006;6:11.
23. . Elston MA. Women and medicine: the future. London: Royal College of Physicians; 2009. p. 159.
24. . Jagsi R, GuancialEA,Worobey CC, et al. The gender gap in authorship of academic medical literature. A 35-
year perspective. N Engl J Med. 2006;355:281–7
25. . Alcon A, Pena˜ T, Arrizabalaga P. Mujeresmédicas e investigaciónensalud. Med Clin. 2012;138:343–8.
26. . Mayoroba T, Stevens F, Scherpbier A, et al. Gender-related differences in general practice preferences:
longitudinal evidence from Netherlands 1982-2001. Health Policy. 2005;72:73–80. 23.
27. Arrizabalaga P, Valls-Llobet C. Mujeresmédicas: de la incorporación a la discriminación. Med Clin.
2005;125:103–7.
28. Cohen, S. (2016, April 11). A Brief History of Sexual Harassment in America Before Anita Hill. Time
Magazine
29. National Academies of Sciences, Engineering, and Medicine. (2018). Sexual harassment of women: climate,
culture, and consequences in academic sciences, engineering, and medicine.Washington (DC): National
Academies Press.
30. Barber Pérez P, González López-Valcárcel B. Oferta y necesidad de especialistasmédicosenEspana˜ (2008-
2025). Universidad de las Palmas de Gran Canaria; 2009. p. 170
31. Venkatesh et al. Women in Intensive Care study: a preliminary assessment of international data on female
representation in the ICU physician workforce, leadership and academic positions Critical Care 2018 : 22 (211)
: 2-9.
32. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and
domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014 Mar
4;160(5):344-53.
33. Carr P.L., Ash A.S., Friedman R.H., Scaramucci A., Barnett R.C, Szalacha L., Palepu A., Moskowitz M.A.
Relation of Family Responsibilities and Gender to the Productivity and Career Satisfaction of Medical
Faculty. Ann Intern Med. 1998;129(7):532–538.
34. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic
advancement. Results of a national study of pediatricians. N Engl J Med. 1996 Oct 24;335(17):1282-9.
35. Howell LP, Beckett LA, Nettiksimmons J, Villablanca AC. Generational and gender perspectives on career
flexibility: Ensuring the faculty workforce of the future. Am J Med. 2012;125:719–728.
36. Cécile A etal. Do gender differences affect the interaction during consultations in general practice? Results
from the INTERMEDE study, Family Practice, Volume 31, Issue 6, December 2014, Pages 706–713.

931